This topic is about ending a pregnancy. If you have had unprotected sex in the last 5 days and don't want to become pregnant, see the topic Emergency Contraception.
Abortion is the early ending of a pregnancy.
Sometimes abortion happens on its own. This is called miscarriage or spontaneous abortion. But women can also choose to end a pregnancy by getting surgery or taking medicine.
If you think you might be pregnant, see a doctor as soon as possible. If you are pregnant, this is an important time to learn as much as you can about your options. The earlier you are in your pregnancy, the more options you are likely to have. Also, the risk of problems will be lower.
Your doctor will ask about your medical history and will do a physical examination. You will have lab tests to make sure that you are pregnant. You may also have an ultrasound.
It's not easy to decide to end a pregnancy. You may need some time to think about your choices. Counselling may help you to decide what is best for you. If you're comfortable, you can start by talking with your doctor. Family planning clinics also offer counselling to help you decide what is best for you. You may also want to talk with someone close to you who understands how pregnancy and raising a child would affect your life. Carefully think through your choices, which are to:
It will depend on how many weeks pregnant you are. You may have a choice between a medical abortion (which means taking medicine to end the pregnancy) and a surgical abortion such as vacuum aspiration or dilation and evacuation (D&E).
After 9 weeks, surgical abortion is usually the only option. The risks from having an abortion in the second trimester are higher than in the first trimester.
In Alberta, the majority of abortions done early in the pregnancy are done in specialized abortion clinics. (some are done in hospitals)
Abortions are rarely done after 24 weeks of pregnancy (during the late second trimester and entire third trimester).
Abortions done by doctors are very safe. Less than 1 out of 100 women have a serious problem from an abortion.footnote 5
The safest timing for an abortion is usually during the first trimester. This is when a low-risk medicine or vacuum aspiration procedure can be used.
The most widely used methods for abortion do not prevent a woman from becoming pregnant later.
Keep in mind that you can get pregnant in the weeks right after an abortion. This is a good time to start using birth control that works well and fits your lifestyle.
It will probably take you 1 to 3 weeks to heal and feel better after an abortion. You should not have sex during this time. But when you do have sex again, be sure to use a condom for several weeks or for as long as your doctor tells you to. This will help to prevent infection.
Learning about abortion:
Examinations and tests are used to diagnose a pregnancy and to check for any health conditions you may have that need special consideration. Regardless of whether you know that you would continue a pregnancy or have an abortion, your evaluation will include a medical history, a physical examination, and some laboratory tests.
A physical examination before an abortion includes:
Laboratory tests before an abortion include:
An ultrasound may be done to check your uterus size and shape and to make sure the pregnancy is in the uterus. A transvaginal ultrasound done in the first trimester is the most accurate method of learning how long you have been pregnant.
Medical abortion is the use of medicines to end a pregnancy. Depending on the medicines used, a medical abortion can be done up to about 9 weeks of pregnancy.
Medicines currently available in Canada for inducing abortion are:
See the What to Think About section of this topic for a comparison of medical abortion and surgical abortion.
A surgical abortion ends a pregnancy by surgically removing the contents of the uterus. Different procedures are used for surgical abortion, depending on how many weeks of pregnancy have passed.
Care before and after a surgical abortion includes a physical examination and lab tests, education about what to expect, self-care instructions, symptoms that mean you should call your doctor, and birth control planning.
A D&E is most commonly used during the second trimester because it has a lower complication risk than induction abortion.
See the What to Think About section of this topic for a comparison between medical abortion and surgical abortion.
Your abortion options are affected by your medical history, how many weeks pregnant you are, and what options are available in your region. Not all medical or surgical choices for an abortion are available in all parts of Canada.
The following table lists some of the differences between the most commonly used medical and surgical abortion procedures.
Usually prevents a need for surgical treatment
Is invasive and/or surgical:
Can only be used during early pregnancy (up to about 9 weeks)
Can be used from early to mid-pregnancy:
Takes 2 or more medical visits over 7 to 14 days
Usually takes 1 visit
May take several days to complete (most of the abortion process happens gradually, at home)
Is complete in the time it takes for the procedure
Does not require anesthesia or sedative
Does not require general anesthesia (though it can be used). Local anesthesia, with or without a calming sedative, is typical.
Has a high success rate (about 95%)
Has a high success rate (about 99%)
Causes moderate to heavy bleeding for a short time
Causes light bleeding in most cases
Needs medical follow-up to make sure pregnancy has ended and to check the woman's health
Does not always need medical follow-up
Is a multi-step process
Is a single-step process
In extremely rare cases, leads to severe infection and death (about 1 out of 100,000), slightly higher rate than after surgical abortion
In extremely rare cases, leads to death (less than 1 out of 100,000)
Pain associated with a medical or surgical abortion ranges from mild to severe and depends on each woman's physical and emotional condition.
Some fetal birth defects or medical problems are not commonly diagnosed until the second trimester, when most routine screening tests are done. There are fewer abortion options during the second trimester.
Research suggests that the hormonal changes during pregnancy may be protective and reduce the risk of breast cancer. In the past, there has been concern that an abortion might interrupt these protective hormonal changes and possibly increase the risk of breast cancer. But more recent, carefully done studies have led experts to conclude that there is no link between having an abortion and breast cancer.footnote 2
If you think you may be pregnant, see a doctor for a pregnancy test, examination, and pregnancy counselling as soon as possible. If you are considering ending the pregnancy, this is an important time for learning as much as you can about your options. The earlier you take measures to end a pregnancy, the more medical choices you are likely to have and the less your risk of complications will be.
Surgical abortions are minor surgeries that require a health professional with specialized training. If a medical abortion is not successful, a surgical abortion must be done as follow-up. This is necessary to prevent infection and blood loss and to end the pregnancy, because medical abortion medicines cause birth defects. The following health professionals can perform abortions:
Some health professionals offer medical abortion only and recommend another health professional if a vacuum aspiration becomes necessary. Other health professionals offer medical abortion and manual vacuum aspiration (MVA) if needed. MVA is a simple and effective procedure.
Your health professional will give you information about what to expect after an abortion. Normal symptoms that most women experience include:
The hospital or surgery centre may send you instructions on how to get ready for your surgery. Or a nurse may call you with instructions before your surgery.
Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You will probably stay in the recovery area for a period of time and then you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will go home with a page of care instructions including who to contact if a problem arises.
Less than 1 out of 100 women who have an abortion have serious problems afterward.footnote 3
Call your doctor immediately if you have any of these symptoms after an abortion:
Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:
Medical abortion and vacuum aspiration do not affect your ability to become pregnant in the future.footnote 5 It is possible to become pregnant in the weeks right after an abortion procedure.
Davis VJ (2006). Induced abortion guidelines. SOGC Clinical Practice Guideline No. 184. Journal of Obstetrics and Gynaecology Canada, 28(11): 1014-1027. Also available online: http://www.sogc.org/guidelines/documents/gui184E0611.pdf.
Society of Obstetricians and Gynaecologists of Canada, Society of Gynecologic Oncologists of Canada. (2005). Breast cancer and abortion. SOGC/GOC Joint Committee Opinion No. 158. Journal of Obstetrics and Gynaecology Canada, v27(5): 491. Also available online: http://www.sogc.org/guidelines/index_e.asp.
Canadian Institute for Health Information (2010). Table 8: Number and percentage distribution of induced abortions* reported by Canadian hospitals (excluding Quebec) in 2010, by complication within 28 days of initial induced abortion. Available online: http://www.cihi.ca/CIHI-ext-portal/pdf/internet/TA_10_ALLDATATABLES20120417_EN.
Government of Canada (2017). Mifegymiso (mifepristone and misoprostol tablets)-Updates to product monograph and risk management plan. Canada.gc.ca. http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2017/65030a-eng.php. Accessed November 29, 2017.
Holmquist S, Gilliam M (2008). Induced abortion. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 586-603. Philadelphia: Lippincott Williams and Wilkins.
American College of Obstetricians and Gynecologists (2005, reaffirmed 2011). Medical management of abortion. ACOG Practice Bulletin No. 67. Obstetrics and Gynecology, 106(4): 871-882.
Other Works Consulted
Social and Sexual Issues Committee, Society of Obstetricians and Gynaecologists (2011). Sexual and reproductive health counselling by health care professionals. Journal of Obstetrics and Gynaecology Canada, 33(8): 870-871. Also available online: http://sogc.org/guidelines/documents/gui264PS1108E.pdf.
ByHealthwise StaffPrimary Medical ReviewerSarah Marshall, MD - Family MedicineAnne C. Poinier, MD - Internal MedicineKathleen Romito, MD - Family MedicineAdam Husney, MD - Family MedicineSpecialist Medical ReviewerRebecca H. Allen, MD, MPH - Obstetrics and GynecologyKirtly Jones, MD - Obstetrics and GynecologyFemi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
Current as ofDecember 4, 2017
Current as of: December 4, 2017
Sarah Marshall, MD - Family Medicine
& Anne C. Poinier, MD - Internal Medicine & Kathleen Romito, MD - Family Medicine & Adam Husney, MD - Family Medicine & Rebecca H. Allen, MD, MPH - Obstetrics and Gynecology & Kirtly Jones, MD - Obstetrics and Gynecology & Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
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